Painful words: How a 1980 letter fueled the opioid epidemic

early 40 years ago, a respected doctor wrote a letter to the New England Journal of Medicine with some very good news: Out of nearly 40,000 patients given powerful pain drugs in a Boston hospital, only four addictions were documented.

Doctors had been wary of opioids, fearing patients would get hooked. Reassured by the letter, which called this “rare” in those with no history of addiction, they pulled out their prescription pads and spread the good news in their own published reports.

And that is how a one-paragraph letter with no supporting information helped seed a nationwide epidemic of misuse of drugs like Vicodin and OxyContin by convincing doctors that opioids were safer than we now know them to be.

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On Wednesday, the journal published an editor’s note about the 1980 letter and an analysis from Canadian researchers of how often it has been cited — more than 600 times, often inaccurately. Most used it as evidence that addiction was rare, and most did not say it only concerned hospitalized patients, not outpatient or chronic pain situations such as bad backs and severe arthritis that opioids came to be used for.

“This pain population with no abuse history is literally at no risk for addiction,” one citation said. “There have been studies suggesting that addiction rarely evolves in the setting of painful conditions,” said another.

“It’s difficult to overstate the role of this letter,” said Dr. David Juurlink of the University of Toronto, who led the analysis. “It was the key bit of literature that helped the opiate manufacturers convince front-line doctors that addiction is not a concern.”

Hospital databases were so limited in 1980 that we can’t be confident there weren’t more problems, or cases discovered after patients were discharged, Juurlink said.

The letter was written by Dr. Hershel Jick, a drug specialist at Boston University Medical Center, and a graduate student.

“I’m essentially mortified that that letter to the editor was used as an excuse to do what these drug companies did,” Jick told the Associated Press in an interview on Wednesday. “They used this letter to spread the word that these drugs were not very addictive.”

Jick said his letter only referred to people getting opioids in the hospital for a short period of time and has no bearing on long-term outpatient use. He also said he testified as a government witness in a lawsuit years ago over the marketing of pain drugs.

The new editor’s note in the journal says: “For reasons of public health, readers should be aware that this letter has been ‘heavily and uncritically cited’ as evidence that addiction is rare with opioid therapy.”

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The journal’s top editor, Dr. Jeffrey Drazen, said, “People have used the letter to suggest that you’re not going to get addicted to opioids if you get them in a hospital setting. We know that not to be true.”

The journal also published a report from Dr. Francis Collins, director of the National Institutes of Health, and Dr. Nora Volkow, head of the National Institute on Drug Abuse, pledging to work with industry to develop new ways to reverse and prevent overdoses, to treat addiction, and to find novel, non-addictive drugs for chronic pain.

In the next six weeks, the NIH will hold three workshops with drug company leaders to identify next steps, Collins said. The goal is to cut in half the usual amount of time to develop new treatments — a target borrowed from the Cancer Moonshot project launched by former Vice President Joe Biden to make a decade’s worth of progress toward cures in half that time.

Details have not been worked out, but it could resemble similar partnerships on Alzheimer’s, diabetes, and some other diseases where scientists from government and industry determine pressing needs, develop a work plan and split the cost, Collins said.

“Industry’s interest in this has been muted until recently,” Collins said. Now, “they feel the responsibility and the opportunity to take part in this and they’re not going to stand back and watch.”

With the Food and Drug Administration wanting to speed work on new pain drugs, “the stars are aligning,” Collins said. “I think we can make real progress now.”

This is a strawman of the worst kind. Not only was the author correct, but you have literally nothing to suggest he wasn’t.

Reporting like this has destroyed the lives of millions of the most vulnerable, underserved patient population in America. Suicide rates are higher only among bipolar patients … and the one thing stemming that was opiates.

Doctors act like pain is some sort of ephemeral mood you can just bottle up, ignore, and go about your life as if it doesn’t exist. It shows up in literally every other vital sign … yet you think there’s no way to measure it? Not to mention the life expectancy when left untreated, drops off like you’d expect to see in a diabetic.

I agree as well. It’s the person and not the drug or the doctor. I have been on pain meds for three failed back surgeries. I take them as prescribed and never even think about trying anything else. If you have an addictive attitude I think it would make you more prone to becoming an addict. Non-addictive attitudes like mine show respect for medicine and the doctors. I would like something to help with the pain but I guess it’s just not out there.

If I may there are currently no sure way to treat any addictions effectively by any government programs, medical treatment, law enforcement and even family counseling. Because inside one need someone that is higher and greater than the one in this world. I know of at least one preacher who has helped thousands of addicts on TV channels freely and effortlessly. He is also available on his own website every day and on Youtube. His following are from different countries (UK, Australia, India, Holland, ..) and his Facebook is almost 4 millions. Main thing is it work for those families.

I agree,it’s the people not the drug.I have been prescribed opiates for well over ten years.I always took them as prescribed.Never had addiction problems.You do build a tolerance and have to be switched to something else from time to time.The other problem is the doctors who suddenly for no reason want to take you off of them with no cause of action.Ive seen many people go to “the streets” for relief when doctors do this.Theyll say the laws changed I can’t give you opioids anymore, when asked to provide info on the law they simply ignore the question.That also happened to me and I chose to deal with it which leaves me in bed most days.So in conclusion,I agree, it’s the person,and the doctor in many cases.We all have choices to make.